Vaughan Gething, Cabinet Secretary for Health and Social Services
Winter is always a challenging time for our health and social care services here in Wales, as it is across the UK. I want to update Members on our preparation in Wales for this winter.
Last winter we saw some significant increases in demand on our services but despite these pressures, the ambulance service continued to respond to patients with immediately life-threatening conditions in an average of around five minutes, we saw fewer delays in patients being transferred from an ambulance to hospital staff, delayed transfers of care were down to unprecedented levels, and performance against the key unscheduled care access targets improved when compared to the previous winter.
This is testament to the hard work of all health and social care staff who worked tirelessly to maintain quality of care and treatment during such a difficult time. We must also recognise that pressures on the unscheduled care system are a year round challenge.
Members will be aware that I commissioned a review into the resilience of health and social care services over the winter of 2016/17 and this supports the whole system approach taken to planning our services in Wales has increased resilience. This year is no different; with preparations starting early as always, and health and social care services working together in developing integrated winter resilience plans. This process has involved organisations reflecting on the experiences of last winter and previous years, and been supported by national and local events.
All plans have been submitted and Welsh Government officials have reviewed them and provided constrictive feedback to support the enhancement of the plans. We will continue to work with health boards, local authorities and the ambulance service in readiness for winter.
The plans focus on maintaining patient flow through the healthcare system, including early discharge planning, timely assessment of care and support needs, reablement, step up and step down provision, as well as ensuring packages of care are available to ensure people can be discharged from hospital as soon as they are well enough.
A wide range of positive actions are planned to further improve local and national resilience, including an increase in available bed capacity both in hospital and in the community to mitigate against the anticipated rise in the number of patients with multiple conditions who require admission to hospital over winter. As last year, we will see the strengthening of emergency ambulatory care services to enable patients with specific conditions to be treated without needing to stay in hospital overnight wherever possible.
Other actions taken to improve resilience this winter include strengthening seven-day working; increasing senior decision-making at the hospital front door; extending working hours; additional support for out-of-hours services and care homes; improved use of social workers in hospitals and greater use of pharmacy support.
The Welsh Government has continued to support our health and care services through significant targeted investment and this is making a difference. Nearly £43m has been made available through the Primary Care Fund for 2017/18 to support the delivery of primary care services.£3.8m of which is to support a national programme of innovative pathfinders and pacesetter projects with the aim of testing new and innovative ways of planning, organising and delivering primary care services. One example being the ‘Acute Care in the community - GP Outreach/Acute Clinical response scheme’ in Abertawe Bro Morgannwg which aims to support GPs in strengthening the management of people with a sudden worsening of symptoms of multiple complex conditions on an ongoing basis and the subsequent impact this has on demand on primary and secondary services.
£10m is also being used to support the development of primary care clusters, supporting GP teams, pharmacists, community nurses and therapist, dentists, optometrists, mental health teams, social workers and third sector workers work together.
£60m has also been made available through the Integrated Care Fund (ICF) for 2017/18 to help prevent unnecessary hospital admissions and delays in discharges. One example being the Stay Well@Home service in Cwm Taf, which is operational 7 days a week, 365 days a year, and consists of a multidisciplinary hospital based team sited within the acute hospitals of Prince Charles and Royal Glamorgan – undertaking assessments and commissioning community and third sector support aimed at preventing unnecessary admission.
The 111 Pathfinder project is progressing well, having been rolled out in the Abertawe Bro Morgannwg region and in Carmarthen. The service builds on the success of NHS Direct Wales and the GP Out of Hours service to offer a 24/7 free to call telephone service for non-emergency healthcare in these localities. It has improved access to information, advice, telephone assessment, triage and treatment either by phone or face to face as appropriate - reducing unnecessary demand on acute hospital services.
Dr Andrew Goodall, NHS Wales Chief Executive, has today launched ‘My Winter Health Plan’ as part of the ‘Choose Well’ campaign. To support this, we will be making 10,000 plans available to health boards, public and third sector services over the coming weeks. The plan will enable older people and those with chronic conditions in particular to easily share information about their condition and useful contacts, and improve access to advanced care plans for visiting clinicians. This should help people remain at home this winter.
Our flu immunisation campaign aims to reduce illness and NHS pressures. The target for flu vaccine uptake rate this year is 75% for older people and 55% for those in the at-risk groups and 60% for healthcare workers who have direct patient contact. We have also extended the childhood programme by one school year to school year 4. The programme will cover all 2 and 3 year olds (provided through primary care) and all children in reception class and years 1, 2, 3 and 4 in primary school (provided through the school nursing service). I would encourage anybody eligible for a free flu vaccination to get vaccinated.
We can all play our part and help the NHS. If you are sick or injured and need treatment, please consider whether you can self-care with advice, or be seen or assessed at your pharmacy (for common minor ailments or seasonal flu vaccines for example), GP surgery or Minor Injuries Unit (MIU). People can look at the ‘Choose Well’ website where the public can find useful information on the services available and how to access them. We are also piloting a tool that will provide information about MIUs and A&E departments including a guide to how long they might spend in these facilities; and how they might be better choosing other sites or services that might provide better, and in some cases more appropriate services.
The Welsh Government has also worked closely with the programme team in developing guidance to support services in using effective improvement techniques to improve patient flow. This guidance, ‘Improving Patient Flow: A whole system approach’, will provide advice on implementing good practice in ten key areas aimed at making the most positive impact. The guidance will be issued shortly and is aimed at senior NHS operational and clinical staff, executive teams, and local authorities, particularly social workers and occupational therapists.
Despite the increased resilience built within the system and performance being generally better, it must also be recognised that even with the best preparations in place, there will inevitably be difficult days. Our priority will always be to ensure the safe and efficient delivery of healthcare services throughout the challenging winter period. We are working closely with the services and our hardworking staff to ensure citizens receive the care they need, when and where they need it.